Healthcare Provider Details

I. General information

NPI: 1053427112
Provider Name (Legal Business Name): JOHN ROBERT BEDNAR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MAIN ST
NASHUA NH
03064
US

IV. Provider business mailing address

5 MAIN ST
NASHUA NH
03064
US

V. Phone/Fax

Practice location:
  • Phone: 603-883-0727
  • Fax: 603-883-5527
Mailing address:
  • Phone: 603-883-0727
  • Fax: 603-883-5527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1339
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12648
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: